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Maximos S, Vaillancourt-Jean É, Mouksassi S, De Cassai A, Ayoub S, Ruel M, Desroches J, Hétu PO, Moore A, Williams S. Peak plasma concentration of total and free bupivacaine after erector spinae plane and pectointercostal fascial plane blocks. Can J Anaesth 2022; 69:1151-1159. [PMID: 35513684 DOI: 10.1007/s12630-022-02260-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/13/2021] [Accepted: 02/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Erector spinae plane blocks (ESPB) and pectointercostal fascial (PIFB) plane blocks are novel interfascial blocks for which local anesthetic (LA) doses and concentrations necessary to achieve safe and effective analgesia are unknown. The goal of this prospective observational study was to provide the timing (Tmax) and concentration (Cmax) of maximum total and free plasma bupivacaine after ESPB in breast surgery and after PIFB in cardiac surgery patients. METHODS Erector spinae plane blocks or PIFBs (18 patients per block; total, 36 patients) were performed with 2 mg⋅kg-1 of bupivacaine with epinephrine 5 μg⋅mL-1. Our principal outcomes were the mean or median Cmax of total and free plasma bupivacaine measured 10, 20, 30, 45, 60, 90, 180, and 240 min after LA injection using liquid chromatography with tandem mass spectrometry. RESULTS For ESPB, the mean (standard deviation [SD]) total bupivacaine Cmax was 0.37 (0.12) μg⋅mL-1 (range, 0.19 to 0.64), and the median [interquartile range (IQR)] Tmax was 30 [50] min (range, 10-180). For ESPB, the mean (SD) free bupivacaine Cmax was 0.015 (0.017) μg⋅mL-1 (range, 0.003-0.067), and the median [IQR] Tmax was 30 [20] min (range, 10-120). After PIFB, mean plasma concentrations plateaued at 60-240 min. For PIFB, the mean (SD) total bupivacaine Cmax was 0.32 (0.21) μg⋅mL-1 (range, 0.14-0.95), with a median [IQR] Tmax of 120 [150] min (range, 30-240). For PIFB, the mean (SD) free bupivacaine Cmax was 0.019 (0.010) μg⋅mL-1 (range, 0.005-0.048), and the median [IQR] Tmax was 180 [120] min (range, 30-240). For both ESPB and PIFB, we observed no correlations between pharmacokinetic and demographic parameters. CONCLUSION Total and free bupivacaine Cmax observed after ESPB and PIFB with 2 mg⋅kg-1 of bupivacaine with epinephrine 5 μg⋅mL-1 were five to twenty times lower than levels considered toxic in the literature.
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Affiliation(s)
- Sarah Maximos
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Éric Vaillancourt-Jean
- Département de Biochimie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Samer Mouksassi
- Faculté de Pharmacie, Université de Montréal, Montreal, QC, Canada
| | - Alessandro De Cassai
- UOC Anesthesia and Intensiva Care Unit, Padua University Hospital, Padua, Veneto, Italy
| | - Sophie Ayoub
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Monique Ruel
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Julie Desroches
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
| | - Pierre-Oliver Hétu
- Département de Biochimie, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Alex Moore
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada.
| | - Stephan Williams
- Département d'Anesthésiologie, Centre hospitalier de l'Université de Montréal, Montreal, QC, H2L 4M1, Canada
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Tijanic M, Buric N. A randomized anesthethic potency comparison between ropivacaine and bupivacaine on the perioperative regional anesthesia in lower third molar surgery. J Craniomaxillofac Surg 2019; 47:1652-1660. [DOI: 10.1016/j.jcms.2019.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/08/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
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Efficacy and safety of 1% ropivacaine for postoperative analgesia after lower third molar surgery: a prospective, randomized, double-blinded clinical study. Clin Oral Investig 2016; 21:779-785. [PMID: 27114091 DOI: 10.1007/s00784-016-1831-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate postoperative analgesic effect of ropivacaine administered as main or supplemental injection for the inferior alveolar nerve block (IANB) in patients undergoing lower third molar surgery. MATERIALS AND METHODS The double-blind randomized study comprised 72 healthy patients. All patients received two blocks, the IANB for surgical procedure + IANB after surgery for postoperative pain control, and were divided into three groups: (1) 2 % lidocaine/epinephrine + 1 % ropivacaine, (2) 2 % lidocaine/epinephrine + saline, and (3) 1 % ropivacaine + saline. The occurrence of postoperative pain, pain intensity and analgesic requirements were recorded. Data were statistically analyzed using chi-square, Fisher, and Kruskal-Wallis tests and analysis of variance (ANOVA) with Bonferroni and Tukey correction. RESULTS Ropivacaine was more successful than lidocaine/epinephrine in obtaining duration of postoperative analgesia, reduction of pain, and analgesic requirements whether ropivacaine was used for surgical block or administered as a supplemental injection after surgery. CONCLUSIONS Ropivacaine (1 %, 2 ml) resulted in effective postoperative analgesia after lower third molar surgery. CLINICAL RELEVANCE Since pain control related to third molar surgery requires the effective surgical anesthesia and postoperative analgesia, the use of 1 % ropivacaine could be clinically relevant in a selection of appropriate pain control regimen for both surgical procedure and early postsurgical treatment.
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Leblanc I, Chterev V, Rekik M, Boura B, Costanzo A, Bourel P, Combes M, Philip I. Safety and efficiency of ultrasound-guided intermediate cervical plexus block for carotid surgery. Anaesth Crit Care Pain Med 2016; 35:109-14. [DOI: 10.1016/j.accpm.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022]
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Pintaric TS, Kozelj G, Stanovnik L, Casati A, Hocevar M, Jankovic VN. Pharmacokinetics of levobupivacaine 0.5% after superficial or combined (deep and superficial) cervical plexus block in patients undergoing minimally invasive parathyroidectomy. J Clin Anesth 2009; 20:333-337. [PMID: 18761239 DOI: 10.1016/j.jclinane.2008.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Revised: 12/25/2007] [Accepted: 01/03/2008] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the pharmacokinetic profile of 0.35 mL/kg of 0.5% levobupivacaine during superficial and combined (deep and superficial) cervical plexus block (CPB) in patients undergoing minimally invasive parathyroidectomy. DESIGN Prospective randomized study. SETTING Operating theater of a university hospital. PATIENTS 12 ASA physical status II and III patients (11 women and 1 man), scheduled for minimally invasive parathyroidectomy. INTERVENTIONS Seven and 5 patients were randomly assigned to receive either superficial or combined CPB, respectively. The superficial CPB was performed with an injection of 0.35 mL/kg of 0.5% levobupivacaine subcutaneously along the posterior border of the sternocleidomastoid muscle and deeper on its medial surface. The combined CPB was initiated by the deep block at the C3 level vertebra by injecting 0.2 mL/kg of 0.5% levobupivacaine, followed by the superficial block with an injection of the remaining 0.15 mL/kg. After completion of the block, venous blood was sampled at the intervals of 5, 10, 15, 20, 30, 45, and 60 minutes. MEASUREMENTS AND MAIN RESULTS Venous plasma concentrations were measured using gas chromatography-mass spectroscopy. Mean +/- SD of maximal concentrations of levobupivacaine was 0.58 +/- 0.41 mg/L in group superficial and 0.52 +/- 0.28 mg/L in group combined (P = 0.71). The median (range) time required to reach the maximal concentrations was 30 minutes (20-30 min) in group superficial and 20 minutes (15-30 min) in group combined (P = 0.45). The areas under the drug concentration/time curve (AUC(10-60)) were also similar in both groups. No signs of central nervous system or cardiovascular toxicity or other untoward events were observed in any patient. CONCLUSION With the given dose regimen, levobupivacaine plasma concentrations were within safe ranges.
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Affiliation(s)
| | - Gordana Kozelj
- Institute of Forensic Medicine, Medical Faculty of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Lovro Stanovnik
- Institute of Pharmacology and Experimental Toxicology, Medical Faculty of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Andrea Casati
- Department of Anesthesia, Medical Faculty, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Marko Hocevar
- Department of Surgery, Institute of Oncology, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Vesna Novak Jankovic
- Department of Anaesthesiology and Intensive Therapy, Clinical Center Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia
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Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications †. Br J Anaesth 2007; 99:159-69. [PMID: 17576970 DOI: 10.1093/bja/aem160] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Carotid endarterectomy is commonly conducted under regional (deep, superficial, intermediate, or combined) cervical plexus block, but it is not known if complication rates differ. We conducted a systematic review of published papers to assess the complication rate associated with superficial (or intermediate) and deep (or combined deep plus superficial/intermediate). The null hypothesis was that complication rates were equal. Complications of interest were: (1) serious complications related to the placement of block, (2) incidence of conversion to general anaesthesia, and (3) serious systemic complications of the surgical-anaesthetic process. We retrieved 69 papers describing a total of 7558 deep/combined blocks and 2533 superficial/intermediate blocks. Deep/combined block was associated with a higher serious complication rate related to the injecting needle when compared with the superficial/intermediate block (odds ratio 2.13, P = 0.006). The conversion rate to general anaesthesia was also higher with deep/combined block (odds ratio 5.15, P < 0.0001), but there was an equivalent incidence of other systemic serious complications (odds ratio 1.13, P = 0.273; NS). We conclude that superficial/intermediate block is safer than any method that employs a deep injection. The higher rate of conversion to general anaesthesia with the deep/combined block may have been influenced by the higher incidence of direct complications, but may also suggest that the superficial/combined block provides better analgesia during surgery.
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Affiliation(s)
- J J Pandit
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Deleuze A, Gentili ME, Vial G. [Locoregional anesthesia in otorhinolaryngology: facial blocks]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2004; 23:1110-3. [PMID: 15581731 DOI: 10.1016/j.annfar.2004.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- A Deleuze
- Département d'anesthésie-réanimation, clinique de l'Espérance, Groupe A Tzanck, 122, avenue du Dr-M.-Donat, 06250 Mougins, France.
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Abstract
The management of anesthesia for patients undergoing carotid endarterectomy is challenging and dynamic. Effective management and good outcome requires the anesthesiologist's understanding of cerebral physiology, knowledge of neck anatomy, and understanding of the rapid pathophysiologic changes that occur during carotid artery manipulations. The anesthesiologist must be flexible in the management of patients, who frequently have underlying multiorgan pathology and cardiovascular compromise. Good communication between the anesthetic and surgical teams is needed to avoid irreversible debilitating consequences for the patient.
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Affiliation(s)
- Konstantin Yastrebov
- Tasmanian Institute of Critical Care, Mersey Community Hospital, Bass Highway, P.O. Box 146, Latrobe, Tasmania 7307, Australia.
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Aunac S, Carlier M, Singelyn F, De Kock M. The Analgesic Efficacy of Bilateral Combined Superficial and Deep Cervical Plexus Block Administered Before Thyroid Surgery Under General Anesthesia. Anesth Analg 2002. [DOI: 10.1213/00000539-200209000-00039] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Aunac S, Carlier M, Singelyn F, De Kock M. The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia. Anesth Analg 2002; 95:746-50, table of contents. [PMID: 12198064 DOI: 10.1097/00000539-200209000-00039] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED In this study we evaluated the analgesic efficacy of combined deep and superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia. For this purpose, 39 patients undergoing elective thyroid surgery were randomized to receive a bilateral combined deep and superficial cervical block (14 mL per side) with saline (Group 1; n = 13), ropivacaine 0.5% (Group 2; n = 13), or ropivacaine 0.5% plus clonidine 7.5 microg/mL (Group 3; n = 13). Deep cervical plexus block was performed with a single injection (8 mL) at the C3 level. Superficial cervical plexus block consisted of a subcutaneous injection (6 mL) behind the lateral border of the sternocleidomastoid muscle. During surgery, the number of additional alfentanil boluses was significantly reduced in Groups 2 and 3 compared with Group 1 (1.3 +/- 1.0 and 1.1 +/- 1.0 vs 2.6 +/- 1.0; P < 0.05). After surgery, the opioid and non-opioid analgesic requirements were also significantly reduced in Groups 2 and 3 (P < 0.05) during the first 24 h. Except for one patient in Group 3, who experienced transient anesthesia of the brachial plexus, no side effect was noted in any group. We conclude that combined deep and superficial cervical plexus block is an effective technique to alleviate pain during and immediately after thyroidectomy. IMPLICATIONS Combined deep and superficial cervical plexus block is an effective technique to reduce opioid requirements during and after thyroid surgery.
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Affiliation(s)
- Sophie Aunac
- Department of Anesthesiology, University of Louvain, St. Luc Hospital, av. Hippocrate 10-1821, 1200 Brussels, Belgium
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